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Peripheral nerve injuries due to sports are relatively rare but the exact incidence is not known due to a lack of epidemiological studies. Particular sports activities tend to cause certain peripheral nerve injuries including direct acute compression or stretching, repetitive compression and stretching over time, or another mechanism such as ischemia or laceration. These nerve lesions may be severe and delay or preclude the athlete's return to sports, especially in cases with delayed diagnosis. Repetitive and vigorous use or overuse makes the athlete vulnerable to disorders of the peripheral nerves, and sports equipment may cause compression of the nerves. Depending on etiology, the treatment is primarily conservative and includes physiotherapy, modification of movements and sports equipment, shoe inserts, splinting, antiphlogistic drugs, sometimes local administration of glucocorticoids or, lately, the use of extracorporeal shock waves. Most often, cessation of the offending physical activity is necessary. Surgery is only indicated in the rare cases of direct traumatic nerve injury or when symptoms are refractory to conservative therapy. Prognosis mainly depends on the etiology and the available options of modifying measures.This article is based on the publications "Reuter I, Mehnert S. Engpasssyndrome peripherer Nerven bei Sportlern". Akt Neurol 2012;39:292-308 and Sportverl Sportschad 2013;27:130-146.

A review of our century's efforts to overcome nerve defects reveals the conclusion that today microsurgical techniques and interfascicular nerve grafting offer the best chances to get success in peripheral nerve repair. There exists a theoretical grading system of Sunderland, which enables us to understand the very different factors which might influence the sprouting of nerve fibers within the damaged or repaired nerve segments. But in practice, the indication to operate always depends on our own decision. The neurological status and electrophysiological tests can only sometimes facilitate our treatment and judgement on peripheral nerve lesions. The basic principles of microsurgical nerve repair are still valid. Modern techniques have resulted in better prognosis. Vast mobilization to achieve neurorrhaphy by force is obsolete today. Epineural trunk-to-trunk-suture is only allowed after clean cut-injuries. In all other cases we have to prefer a repair by autologous grafting. But some factors still remain which limits our efforts, such as muscle degeneration depending on time interval or ischemic fibrosis after the lesion, direct trauma to the muscle substance or a lesion in the region of nerve ramifications.

Differences in neural damage due to different injection needles were investigated in vitro on sciatic nerve specimens of adult rabbits. METHODS. Three types of 22-gauge needles were tested: one typical, long-bevelled venous puncture needle; a short bevelled, typical nerve block needle; and a tapered, atraumatic spinal needle. Both sciatic nerves of 50 adult rabbits weighing from 2.5 to 3.0 kg were used for electrophysiological investigations on one side and fluorescence microscopy on the other. ELECTROPHYSIOLOGY. The nerve specimens were placed in an experimental chamber on silver-silver chloride electrodes that were aligned at a distance of 10 mm. Two electrodes at the distal ends of the nerve were used for stimulation by rectangular waves (6-10 v) of 0.01 ms duration. The compound action potential (CAP), its amplitude, and its latency were measured by monopolar recording from four additional electrodes (R1 to R4). Ten nerves were apportioned to each of five groups and the needles were perpendicularly pierced three times in the middle of the nerve trunk at the midpoint between recording sites R2 and R3. THE GROUPS. 1. Long-bevelled needle, the face of the bevel inserted rectangular to the nerve fibers; 2. long-bevelled needle, the face of the bevel parallel to the nerve fibers; 3. short-bevelled needle, the face of the bevel inserted rectangular to the nerve fibers; 4. short-bevelled needle, the face of the bevel parallel to the nerve fibers; 5. tapered, pencil-point needle pierced perpendicularly through the nerve trunk. The amplitude of the CAP was recorded before and after nerve injury from R1 to R4. FLUORESCENCE MICROSCOPY. According to the method described by Steinwall and Olsson, the other five groups of injured nerves were immersed in Evans blue albumin (EBA) and, after washing in saline solution, fixed in 5% formalin. The extent of nerve damage was evaluated by fluorescence microscopy of the glycerol-imbedded frozen sections (longitudinal and transverse). RESULTS. Electrophysiology. After injuring the area between R2 and R3 there was almost no change in the amplitude of the CAP at sites R1 and R2. The amplitude at R3 and R4 was reduced in comparison with the controls. This reduction was most marked in group 1 and very slight in group 5. The percentages of amplitude at R3 after injury compared with control values (mean +/- SD) were 42.2% +/- 22.0% in group 1; 60.9% +/- 18.2% in group 2; 51.0% +/- 22.3% in group 3; 71.0% +/- 18.0% in group 4; and 90.1% +/- 10.9% in group 5. Statistically significant differences were obtained between the tapered, atraumatic needle group and the other four groups (Fig. 3). Fluorescence microscopy. With the tapered injection needle there was the least leakage of EBA, which suggests the least damage to the perineurium, and almost no rupture or tearing of the nerve fibers was observed. In the short- and long-bevelled needles, the damage was reduced when the face of the bevel was inserted parallel to the fibers.

In a retrospective study 674 nerve injuries of the upper limb were analysed, which were treated by operative management in 10 hospitals of the GDR. The median nerve (226 cases) and the ulnar nerve (209 cases) most were frequently concerned. 427 injured nerves were reconstructed primary or early secondary. In 46.3% epineural nerve suture was performed and in 23% interfascicular nerve grafting. Good or very good results occurred in 71% (motor recovery) and 70.7% (sensory recovery) according to the scheme of Highet. The best results occurred after primary reconstruction independent of operative technique. The results get worse with increasing age.

Peripheral nerve injuries may complicate extracranial vascular surgery. Pareses of the recurrent and hypoglossal nerves are clinically important. The nervus laryngeus superior, the ramus marginalis mandibulae of the facial nerve and the brachial plexus may be involved. Horner's syndrom indicating damage of sympathetic fibers may also appear. Lesions of the glossopharyngeal, vagus and phrenic nerves are rather seldom.

The authors re-examine cases of complete peripheral nerve injury of the upper extremity. Motor activity and sensibility assessment make use of Highet's scale. Some general principles of surgical treatment of peripheral nerve injuries are presented and individual factors which influence its results are worked out, e.g. moment of diagnosis, kind of nerve suture, moment of operation, age of patient, grade of injury, concomitant injuries, and length of graft. Conclusions are drawn for the concept of treatment.

Peripheral nerve injuries are often encountered in traumatological care. The aim of this manuscript is to provide initial data, experiences and performance reports from Germany in the implantation of acellular human nerve transplants in peripheral sensory nerve defects of the hand and to put these data in the context of a comprehensive review of the literature. Of the patients 4 (7 digital nerves) were examined 6 months postoperatively and 5 patients (6 digital nerves) were examined 1 year after the operation (3 were also at the 6‑month examination). All patients had a clinical improvement after nerve reconstruction (≥ S3 according to the classification of sensory recovery of the Medical Research Council modified by Mackinnon and Dellon). Disadvantages of our clinical study are the small number of patients, the inhomogeneity (primary and secondary nerve reconstruction) and the lack of comparison with other nerve reconstruction methods.Verletzungen peripherer Nerven werden regelmäßig in der traumatologischen Versorgung angetroffen. Ziel dieser Arbeit ist es, erste Daten, Erfahrungen und Anwendungsberichte aus Deutschland bei der Implantation von azellulären humanen Nerventransplantaten bei peripheren sensiblen Nervendefekten an der Hand anzubieten und diese Daten in den Kontext einer umfassenden Literaturübersicht zu stellen. Bei der 6-Monats-Untersuchung konnten 4 Patienten (7 Nervi digitalis propii) nachuntersucht werden. Ein Jahr postoperativ konnten 5 Patienten (6 Nervi digitalus propii) nachuntersucht werden (3 davon waren auch bei der 6-Monats-Untersuchung). Alle Patienten hatten eine klinische Verbesserung nach der Nervenrekonstruktion (≥ S3 nach der Klassifikation der sensiblen Regeneration nach dem Medical Research Council modifiziert durch Mackinnon und Dellon). Nachteile dieser klinischen Studie sind die kleine Anzahl von Patienten, die Inhomogenität (primäre und sekundäre Nervenrekonstruktion) sowie der fehlende Vergleich zu einer anderen Nervenrekonstruktionsmethode.

Traumatic nerve injuries are associated with a high morbidity and long rehabilitation times. The extent of a nerve lesion and the related regeneration potential can often only be estimated during the course, whereby the time window for successful surgical interventions is limited.The incidence and distribution of traumatic nerve lesions are reported. Algorithms for treatment decisions are presented.Statistics from the German TraumaRegister DGU® as well as international registers were evaluated. The results of basic research and expert recommendations for diagnostics and treatment are discussed.A strategic approach to conservative and surgical treatment of traumatic nerve injuries depending on the extent of injury and resulting regeneration potential is recommended. In conjunction with the clinical course, electrophysiology and imaging diagnostics, e.g. nerve sonography, can help to differentiate between neurapraxia, axonotmesis and neurotmesis.HINTERGRUND: Traumatische Nervenverletzungen gehen mit einer hohen Morbidität und langen Rehabilitationszeiten einher. Das Ausmaß der Nervenschädigung mit dem damit verbundenen Regenerationspotenzial kann oft erst im Verlauf eingeschätzt werden, wobei das Zeitfenster für erfolgreiche chirurgische Interventionen begrenzt ist.Inzidenz und Verteilung traumatischer Nervenläsionen, Darstellung von Algorithmen zur Therapieentscheidung.Auswertung von Statistiken aus dem TraumaRegister DGU® sowie internationalen Registern. Diskussion von Grundlagenarbeiten und Expertenempfehlungen zu Diagnostik und Therapie.Ein strategisches Vorgehen bei der konservativen und operativen Behandlung von Nervenläsionen in Abhängigkeit vom Ausmaß der Schädigung und dem resultierenden Regenerationspotenzial ist empfohlen. In Zusammenschau mit dem klinischen Verlauf können elektrophysiologische und bildgebende Diagnostik wie die Nervensonographie helfen, zwischen Neurapraxie, Axonotmesis und Neurotmesis zu unterscheiden.

In the early stage of nerve lesions, the clinical differentiation between neurapraxia, axonotmesis and neurotmesis often presents a big challenge. Especially in the early stage, however, it is crucial to correctly classify the type of damage because this is what essentially determines the therapeutic concept, in particular the surgical approach and, therefore, the prognosis. A precise diagnosis not only requires detailed clinical assessment and medical history taking, but also the use of additional electrophysiological (functional) and/or imaging examinations. Electrophysiological diagnostic tests may provide information ion localization, severity, course, type of damage and incipient or past reinnervation. Preoperative functional diagnostic measures should include neurography, needle electromyography (EMG) and, if needed, evoked potentials (EP), while imaging procedures should include neural sonography and magnetic resonance imaging (MRI). As a complimentary procedure, EMG may also be performed during surgery.Im Frühstadium von Nervenläsionen stellt die klinische Differenzierung zwischen Neurapraxie, Axonotmesis und Neurotmesis oftmals eine große Herausforderung dar. Vor allem im Frühstadium von Nervenläsionen ist eine korrekte Klassifizierung des Schädigungstyps jedoch von essenzieller Bedeutung, da hiermit das therapeutische Konzept, insbesondere das operative Vorgehen und damit die Prognose, maßgebend bestimmt werden. Neben einer ausführlichen klinischen Statuierung und Anamneseerhebung bedarf es zur Präzisierung der Diagnose den Einsatz ergänzender elektrophysiologischer (funktioneller) und/oder bildgebender Untersuchungen. Eine elektrophysiologische Diagnostik kann hierbei Auskunft über Lokalisation, Schweregrad, Verlauf, Schädigungstyp und einer beginnenden oder stattgehabten Reinnervation geben. Präoperativ sollten hinsichtlich der funktionellen Diagnostik eine Neurografie, Nadel-Elektromyografie (EMG) und ggf. evozierte Potentiale (EP) und bildgebend eine Nervensonografie oder Magnetresonanztomografie (MRT) durchgeführt werden. Ergänzend kann eine EMG auch intraoperativ erfolgen.

The complication rate after 844 implantations of total endoprosthesis in the hip-joint, in the form of postoperative nerve injuries was found to be about 1 per cent. A number of causes may be responsible for nerve lesions, and some of these may be eliminated with a sparing operative technique. Although there are good prospects for the disappearance of paralytic symptoms, meaningful pysiotherapeutic after-care is very important. In the paralytic stage consistent exponential electrotherapy is recommended, and for recurring voluntary mobility active exercises against resistance. This will greatly improve the functional result of an operation with regard to nerve lesions.

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.

Lesions of peripheral nerves substantially influence the long-term prognosis and functional outcome. Approximately 70% of peripheral nerval lesions are associated with vascular injuries and occur more frequently with certain fractures and osteosynthesis types. The prognosis and treatment depend on the severity of the injury and the presence of axonal lesions, in particular, determines the further procedure. Treatment as early as possible is associated with a clear improvement in the prognosis. Defects longer than 8 mm in size necessitate a nerve transplantation. Iatrogenic vascular lesions occur particularly in percutaneous interventions and are reported in up to 8% of cases after operations involving the musculoskeletal system. Iatrogenic nerve lesions are almost exclusively the result of surgical procedures and represent up to 17.5% of traumatic nerve injuries. For all lesions the general principles of surgical treatment are valid and the rapid involvement of professional expertise is decisive.

A small portion of patients suffer from severe knee pain following previous knee surgery or a trauma. Awareness among traumatologists regarding a neuropathic origin of this persistent knee pain is poor. Ongoing pain close to the knee may be caused by damage of the infrapatellar nerve (IN). This branch of the saphenous nerve is purely sensory and is at risk for iatrogenic damage due to its superficial medial course. Once recognized using simple tests during physical examination, a variety of treatment modalities may be proposed. However, a standard treatment algorithm was hitherto absent. This study includes 15 patients having IN damage who were offered a step-up regimen including lidocaine injections, pulsed radiofrequency (PRF) or neurectomy. Success (50% drop in numeric rating scale pain score) was attained in 11 (73% success rate, 9 month median follow-up). The aim of this contribution is to increase knowledge regarding this illusive entity and to discuss the efficacy of our treatment protocol.

Traumatic peripheral nerve lesions affect patients of all age groups. They are associated with functional deficits that have severe consequences for affected patients and prolonged or permanent inability to work has socioeconomic relevance. In order to improve prognoses and achieve the best possible outcome an early diagnosis and competent knowledge of the correct approach and treatment strategies are essential. Unfortunately, nerve lesions are often not detected in time, so that surgical treatment can only be initiated after a delay. Because of the relatively high proportion of iatrogenic nerve lesions, a profound knowledge of the optimal care of patients with peripheral nerve lesions is compulsory for every doctor who works in the operative field. Surgical treatment of peripheral nerve lesions should remain in the hands of experienced peripheral nerve surgeons. The foundation of successful treatment, however, begins earlier at the initial referral when the patient receives the correct diagnostics and treatment.

Nerve tubes are used for bridging of short nerve gaps and for coating of primary end-to-end nerve sutures. This article provides an overview of available implants and their application. Also it presents a retrospective planning study aiming to determine the static 2-point discrimination after primary peripheral nerve repair with and without the use of a nerve tube. The results have been used to determine the sample size of a prospective randomised trial.54 peripheral nerve injuries of 41 patients were treated by primary end-to-end nerve sutures with or without the additional use of a nerve tube (n=28 and n=26, respectively). 38 digital nerves and 16 median and ulnar nerves were affected. Nerve tubes were used for the repair of 15 digital nerves and 13 median and ulnar nerves. Clinical follow-up was performed 46 months after surgery (patients without nerve tubes) and 18 months after surgery (patients with nerve tubes), respectively. Static 2-point discrimination (2PD) was measured by double-tip compasses (weight: 18 g) and patients were examined for clinical signs of neuroma. Further examinations included grip strength as a percentage value compared with the uninjured hand and, in case of finger injuries, the range of motion in the proximal and distal interphalangeal joints, Strickland score, DASH score and implant-associated complications.In patients with primary end-to-end sutures for finger injuries, there were no statistically significant differences between treatment with and without nerve tubes regarding 2PD, grip strength, DASH- or Strickland score. However, 2PD values of patients with nerve tubes had an increased spread. Average 2PD in digital nerves was 4.5 mm (3-15; SD: 3.9) without nerve tubes and 5.5 mm (3-15; SD: 5) with nerve tubes. Average 2PD after lesions of the median and ulnar nerves was 10 mm (3-15; SD: 5.9 and 5.4, respectively) in both groups.The additional use of a nerve tube showed no superiority in this planning study. The expected average 2PD is 5 mm after digital nerve injuries and 10 mm after lesions of the median or ulnar nerves.

The randomized controlled trial (RCT) presented in this article showed significant relief in neuropathic pain following subcutaneous injections of botulinum toxin A over 24 weeks compared to placebo. This result was confirmed in a novel post-hoc analysis of the subgroup of 46 patients with peripheral nerve injury. Relevant adverse effects did not occur during the RCT.